Fatal respiratory diphtheria in a visitor to Canada

Provide prompt diagnosis and treatment

Report promptly to local public health

Institute appropriate infection prevention and control measures

Support assessing close contacts (via collection of nasopharyngeal and throat swabs)

Support follow-up of any health care workers identified as close contacts who require contact management

Local public health:

• Begin contact management immediately

• Conduct local surveillance

• Support collection of swabs and immunization of contacts

• Lead community contact management

• Lead community messaging, if required

Provincial public health (e.g., Ministry of Health, Public Health Ontario):

• Coordinate access to diphtheria antitoxin

• Provide advice or consultation to local public health

• Conduct provincial disease surveillance

• Coordinate notification to Public Health Agency of Canada, as needed

National public health (e.g., Public Health Agency of Canada):

• Conduct national surveillance activities

• Liaise with other national governments for contact tracing in home country, as needed

Front-line laboratories:

• Process primary specimens and provide preliminary identification

Provincial reference microbiology laboratories:

• Confirm identification, and if determined to be Corynebacterium diphtheriae, submit isolate to National Microbiology Laboratory

• Process primary samples to culture specifically for C. diphtheriae when suspected (e.g., contacts of a case)

National Microbiology Laboratory:

• Perform tox-gene polymerase chain reaction testing (PCR) to determine if isolate possesses the toxin gene; if tox PCR is positive, perform a modified Elek test to definitively show that the isolate produces diphtheria toxin

All levels: Provide advice regarding testing, turnaround times, interpretation